Risk Factors for Adhesive Capsulitis
Adhesive capsulitis predominantly affects individuals aged 40-65 years with diabetes mellitus and thyroid disease representing the most significant systemic risk factors, while female sex, prior shoulder injury, and post-stroke status constitute additional major risk categories. 1, 2
Primary Systemic Risk Factors
Diabetes Mellitus
- Diabetes is the single most important systemic risk factor, with adhesive capsulitis affecting approximately 14-29% of type 2 diabetic patients compared to 2-5% of the general population 2, 3, 4
- The association strengthens with longer diabetes duration, though the relationship is not always statistically significant across all studies 3, 4
- Diabetic patients with adhesive capsulitis demonstrate higher rates of other diabetic complications, particularly retinopathy (OR = 2.2,95% CI 1.1-4.2) 4
- The presence of adhesive capsulitis in diabetic patients may indicate broader organ involvement and correlates with limited joint mobility (OR = 2.1) and Dupuytren's disease (OR = 2.4) 4
Thyroid Disease
- Thyroid dysfunction represents a well-established risk factor, though the exact mechanism remains unclear 2
Demographic Risk Factors
Age
- Peak incidence occurs between ages 40-65 years, with age representing an independent risk factor 1, 2, 4
- The condition rarely affects individuals under 40 years 5
Female Sex
- Women demonstrate higher prevalence, though the association is not universally statistically significant across all populations 5
Post-Stroke and Neurological Risk Factors
Hemiplegic Shoulder
- Up to 67% of stroke patients with combined motor, sensory, and visuoperceptual deficits develop shoulder-hand-pain syndrome 6
- Spasticity correlates with shoulder complications, though definitive causation remains unconfirmed 6
- Inadequate protection of the hemiplegic limb increases trauma risk and subsequent capsulitis 6
Iatrogenic Factors in Stroke Patients
- Improper handling during rehabilitation, particularly overhead pulley exercises, significantly increases risk 6, 7
- Shoulder tissue injury (effusion, tendinopathy, rotator cuff tears) occurs in approximately one-third of acute stroke patients and may contribute to capsulitis development 6
Trauma and Immobilization Risk Factors
Prior Shoulder Injury
- Previous shoulder injury, including rotator cuff tears, fractures, and surgery, increases risk 2, 3
- Shoulder immobilization after any shoulder surgery or injury directly contributes to frozen shoulder development 7
- Failure to initiate formal physical therapy within 6-8 weeks post-injury or post-surgery may result in permanent shoulder dysfunction 7
Associated Musculoskeletal Conditions
Hand and Upper Extremity Disorders
- Limited joint mobility shows significant association (p = 0.006, OR = 2.1) 4
- Dupuytren's disease demonstrates strong correlation (p = 0.003, OR = 2.4) 4
- Carpal tunnel syndrome shows modest association (OR = 1.4) 4
Other Joint Involvement
- Patients with polyarticular hand osteoarthritis face increased risk of adhesive capsulitis as part of generalized osteoarthritis patterns 5
Occupational and Activity-Related Factors
Physical Activity Patterns
- Occupation or recreation-related shoulder usage represents a recognized risk factor 5
- Sedentary versus non-sedentary occupation shows variable association, with some studies finding no significant statistical relationship 3
Critical Clinical Caveats
The presence of adhesive capsulitis in diabetic patients should prompt evaluation for other diabetic complications, particularly retinopathy and other hand problems, as it may indicate broader systemic involvement 4. The condition is self-limiting but typically follows a prolonged course over 2-3 years, making early identification of at-risk patients crucial for timely intervention 2, 8.